Children With Sexual Behavior Problems: Assessment and Treatment.

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Implications for Research and Practice

This research study highlights the need for a strong subject recruitment and retention plan, particularly when working with a child population. While the project was able to recruit and retain sufficient subjects for data analyses, this issue will continue to be problematic in future child treatment outcome research.

One question that arose during the planning stage was that of mixed gender and age groups. The groups were initially designed to be mixed gender but divided by age, i.e., children ages 6-8 in one group and 9-11 in another group. Boys and girls at these ages were thought to be able to work together in groups, but the age difference between 6 and 11 was seen as possibly problematic. However, due to the number of children available each four months to be randomly assigned to groups, it became necessary to randomly assign without regard to age. Children ages 6 to 12 were placed in groups together and there were no problems. While this was not seen as an optimal solution, it worked quite well and continues to be used in the groups continuing today.

A decision was made early in the development of the project to not have a control group, i.e., a no treatment group. This was based on the ethical concerns of withholding treatment to children with sexually inappropriate or aggressive behavior. A group of children with no sexual behavior problems was then recruited for comparison purposes. As there was a group of children who did not complete treatment, these children could be used as a control group. This could be an important group to follow-up as pointed out by Finkelhor and Berliner (1995).

Several clinical recommendations can be made based on the experience of this project. First is the importance of involving the parent/caregivers and impressing on them the importance of attendance and supervision. As children are unable to seek or attend treatment on their own, they are dependent on adults to make and keep appointments. Therefore, it is necessary to engage and keep the caregivers actively involved in the treatment process.

With this particular behavior problem, it is necessary to be highly sensitive to the nature and effect of the children's behavior on their parents/caregivers and the children themselves. It is difficult for many adults to discuss sexual issues and behavior in private, much less in a group with adults they do not know. This was also found to be true for the children, who had to be encouraged to discuss their inappropriate sexual behavior. The use of the Sexual Behavior Rules was found to be highly useful, as the child's behavior was couched in terms of "breaking a rule" rather than as a precursor to becoming an adult sex offender. This tended to reduce the parents' and children's anxiety and reluctance to discuss the actual behavior.

Although the treatment approaches assessed in this project were conducted in a group format, it should be noted that the techniques utilized in the cognitive-behavioral approach have been found to reduce sexual behavior problems in individual therapy with children ages 5 to 12 at OUHSC. While the group model has been reported in the literature as having numerous advantages over individual treatment for adolescents and adults with sexual behavior problems, there is not clear evidence to date that a group approach is the model of choice for children.

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